Pregnancy and neonatal outcomes following malignancy in pregnancy at a tertiary care Canadian center: a retrospective chart review

Figures & data

Figure 1. Study flow diagram of the identification of eligible particpants.

Figure 2. Incidence of PAC per 1000 deliveries between 1 January 2011 – 31 March 2022; (A) livebirths and stillbirths only, (B) including abortions.

Table 1. Demographic and obstetrical characteristics.

Variable	N = 59
Maternal age, years, mean ± SD^a	34.5 ± 5.9
Parity
Multiparous, n (%)	14 (23.7)
Primiparous, n (%)	17 (28.8)
Nulliparous, n (%)	28 (47.5)
Conception type, n (%)
Spontaneous	31 (52.5)
Assisted reproductive technology	2 (3.4)
Missing	26 (44.1)
Number of fetuses, n (%)
1 (Singleton pregnancy)	58 (98.3)
2 or more (Multiple pregnancy)	1 (1.7)
Self-reported alcohol use during pregnancy, n (%)
Yes	7 (11.9)
No	44 (74.6)
Missing	8 (13.5)
Self-reported smoking during pregnancy, n (%)
Yes	4 (6.8)
No	49 (83.0)
Missing	6 (10.2)
Maternal comorbidities (top 5 outside of oncological condition), n (%)
Depression and/or anxiety^b	15 (25.4)
Asthma	5 (8.5)
Hypothyroidism	4 (6.8)
Type 2 diabetes mellitus	3 (5.1)
Crohn’s disease	1 (1.7)
Maternal medication use in pregnancy (top 5 outside of oncological condition), n (%)
Pre-natal vitamins/Folic acid	45 (76.3)
Iron supplement	9 (15.2)
Ventolin (salbutamol)	5 (8.5)
Levothyroxine	5 (8.5)
Opioids	3 (5.1)

^aMaternal age at pregnancy outcome.

^bSelf-reported.

SD: standard deviation.

Table 2. Oncological characteristics and interventions.

Variable	N = 59
Maternal age at cancer diagnosis, years^a	33.4 ± 5.8
Previous cancer diagnosis, n (%)
Yes	6 (10.2)
No	53 (89.8)
Diagnosed during pregnancy
Yes	45 (76.3)
Gestational age at diagnosis, weeks^b	19.7 ± 9.2
No	14 (23.7)
Type of malignancy, n (%)
Breast	17 (28.8)
Hodgkin lymphoma	6 (10.2)
Thyroid	5 (8.5)
Melanoma	3 (5.1)
Basal cell carcinoma	3 (5.1)
Chronic myeloid leukemia	3 (5.1)
Colorectal	3 (5.1)
Cervical	2 (3.4)
Meningioma	2 (3.4)
Non-Hodgkin lymphoma	2 (3.4)
Non-small cell lung cancer	2 (3.4)
Acute lymphoblastic leukemia	1 (1.7)
Dermatofibrosarcoma protuberans	1 (1.7)
Glioblastoma	1 (1.7)
Liposarcoma	1 (1.7)
Multiple myeloma	1 (1.7)
Neuroblastoma	1 (1.7)
Neuroendocrine tumor	1 (1.7)
Oligoastrocytoma	1 (1.7)
Pancreatic	1 (1.7)
Parotid tumor	1 (1.7)
Serous borderline tumor of the ovary	1 (1.7)
Cancer staging completed?
Yes	45 (76.3)
No	14 (23.7)
Tumor stage, n (%)
T1	8 (13.6)
T2	9 (15.2)
T3	6 (10.2)
T4	4 (6.8)
Unknown/Unstageable/Other system^c	32 (54.2)
Type of treatment (pre-pregnancy), n (%)
None	13 (22.0)
Chemotherapy	2 (3.4)
Radiotherapy	2 (3.4)
Surgical intervention	4 (6.8)
Radioactive Iodine Ablation	0 (0.0)
Other^d	1 (1.7)
Type of treatment (during pregnancy), n (%)
None	19 (32.2)
Chemotherapy	20 (33.9)
Radiotherapy^e	1 (1.7)
Surgical intervention	19 (32.2)
Gestational age at surgical intervention	21.6 ± 6.8
Radioactive Iodine Ablation	0 (0.0)
Other^f	14 (23.7)
Type of treatment (post-pregnancy), n (%)
None	13 (22.0)
Chemotherapy	7 (11.9)
Radiotherapy	24 (40.7)
Surgical intervention	20 (33.9)
Radioactive Iodine Ablation	5 (8.5)
Other^g	16 (27.1)

^a/bFor participants missing exact dates (n = 14), the first day of the first month was used as a surrogate to calculate age/gestational age at cancer diagnosis.

^cSome types of malignancies were missing staging information, or classified according to other systems and/or were not stageable and include the following: Acute lymphoblastic leukemia, Anaplastic oligoastrocytoma, Basal cell carcinoma, Chronic myeloid leukemia, Dermatofibrosarcoma protuberans, Glioblastoma, Hogdkin lymphoma, Liposarcoma, Melanoma, Meningioma, Multiple myeloma, Neuroblastoma, Neuroendocrine tumor, Non-Hodgkin lymphoma, Pancreatic tumor, Serous borderline tumor of the ovary.

^d/gOther types of treatments outside of pregnancy included: Abemaciclib, Anastrozole, Atelectinib, Crizotinib, Goserelin, Lenalidomide, Letrozole, Lorlatinib, Octreotide, Palbociclib, Pamidronate, Pertuzumab, Tamoxifen, Trastuzumab, Zoledronic acid, and Stem cell transplant.

^eThe participant underwent peptide receptor radionuclide therapy (PRRT) during pregnancy.

^fOther types of treatments during pregnancy included: Dasatinib, Dexamethasone, Hydrocortisone, Gleevec, Interferon alpha-2B, Peginterferon alpha-2A, Prednisone, Prednisolone, Tamoxifen, Trastuzumab, and naturopathic substances.

Table 3. Obstetrical, maternal, and neonatal outcomes.

Maternal and Obstetrical Outcomes	N = 59
Antenatal hospitalization, n (%)	24 (40.7)
No. antenatal hospitalizations, mean ± SD	1.2 ± 0.4
Pregnancy-related, n (%)	7 (24.1)
Malignancy-related, n (%)	20 (69.0)
Other, n (%)	1 (3.45)
Unknown, n (%)	1 (3.45)
Pregnancy outcome, n (%)
Livebirth	55 (91.7)
Stillbirth	0 (0.0)
Spontaneous abortion	2 (3.3)
Induced abortion	3 (5.0)
Induction of labor, n (%)
Yes^a	19 (32.2)
No	35 (59.3)
N/A	5 (8.5)
Mode of delivery, n (%)
Vaginal	33 (55.9)
Cesarean section^b	21 (35.6)
N/A	5 (8.5)
Type of CS, n (%) (n = 21)
Planned/Scheduled	13 (61.9)
Unplanned/Unscheduled	8 (38.1)
Pregnancy complications
Non-reassuring fetal heart rate/abnormal fetal surveillance	8 (13.6)
PPROM and/or preterm labor	5 (8.5)
Polyhydramnios	3 (5.1)
Hypertensive disease of pregnancy	2 (3.4)
Intrauterine growth restriction	2 (3.4)
Maternal infection	2 (3.4)
Gestational diabetes	1 (1.7)
Oligohydramnios	1 (1.7)
Post-partum maternal complications
Post-partum hemorrhage	3 (5.1)
Endometritis	2 (3.4)
Sepsis	2 (3.4)
Pelvic hematoma	1 (1.7)
Respiratory distress requiring ICU	1 (1.7)
Length of stay for delivery admission, days, mean ± SD	5.0 ± 8.9
Neonatal Outcomes	N = 55
Gestational age at delivery, weeks^c (n = 55)	37.4 ± 2.8
Term delivery (≥37 weeks), n (%)	39 (70.9)
Preterm delivery (<37 weeks), n (%)	16 (29.1)
Birthweight, grams, mean ± SD	2920.3 ± 650.0
<2500 g, n (%)	16 (29.1)
2500–3999 g, n (%)	38 (69.1)
≥4000 g, n (%)	1 (1.8)
Small for gestational age, n (%)	6 (10.9)
Large for gestational age, n (%)	5 (9.1)
Apgar Score <7 at 5 min^d, n (%)	0 (0.0)
Congenital abnormalities^e, n (%)	8 (14.5)
Neonatal complications, n (%)
Neonatal respiratory difficulties	7 (12.7)
Hyperbilirubinemia	4 (7.3)
Bilateral tension pneumothoraxes	2 (3.6)
Caput succedaneum	2 (3.6)
Cephalohematoma	2 (3.6)
Neonatal abstinence syndrome	2 (3.6)
Rash	2 (3.6)
Sepsis	1 (1.8)
Other^f	8 (14.5)
Received breast milk in hospital, n (%)
Yes	35 (63.6)
No	20 (36.4)
Admission to NICU/SCN, n (%)	18 (32.7)
Length of stay in the hospital, days, mean ± SD	5.6 ± 12.2

^aIndications for induction of labor: cancer-related (n = 12, 63.2%), pregnancy-related (n = 5, 26.3%), both cancer and pregnancy-related (n = 2, 10.5%).

^bIndications for cesarean section: cancer-related (n = 5, 23.8%), pregnancy-related (n = 13, 61.9%), both cancer and pregnancy-related (n = 3, 14.3%).

^cDoes not include spontaneous and induced abortions.

^dData is missing for n = 1 (1.8%).

^eCongenital abnormalities include ankyloglossia, bilateral ear tags, club foot, esophageal atresia, hip contractures, malpositioned foot, pelvic kidney, polydactyly, and XXY (suspected).

^fOther neonatal complications include abnormal white blood cell differential, bradycardia, choroid plexus cysts, gastroesophageal reflux, HIV-exposed infant, hypoglycemia, neutropenia secondary to in utero chemotherapy exposure, and urinary retention secondary to opioids.

CS: Cesarean section; ICU: Intensive care unit; NICU/SCN: Neonatal intensive care unit/Special care nursery; PPROM: Preterm premature rupture of membranes; SD: Standard deviation.